We congratulate Alice M. Horowitz, Ph.D., and colleagues on making a strong case for increased awareness of oral cancer ("Oral Pharyngeal Cancer Prevention and Early Detection: Dentists’ Opinions and Practices," April JADA).
While the majority of these cases occur in patients over the age of 40 years with histories of alcohol and/or tobacco use, recent reports show that one of the fastest growing demographic groups of new oral cancer cases consists of young adults under the age of 40 years.
A nearly fivefold increase in incidence has been shown. Many of these patients have minimal or no exposure to risk factors, and a viral etiology has been suggested. We became aware of this trend when reviewing the literature after the biopsy of a 19-year-old woman with no risk factors returned positive for invasive squamous cell carcinoma of the tongue. The patient’s history and clinical examination were completely consistent with a nonhealing traumatic ulcer.
This new information further demonstrates the need for thorough clinical examination of all patients and increased awareness of this devastating disease.
As our knowledge of the cancer process evolves, we will likely need to alter our criteria regarding an index of suspicion.
